Healthcare Provider Details

I. General information

NPI: 1306962519
Provider Name (Legal Business Name): JAMES R WEAGLEY, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24355 LYONS AVE SUITE 130
NEWHALL CA
91321-2300
US

IV. Provider business mailing address

20280 SORRENTO LN APT 208
PORTER RANCH CA
91326-4482
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-9355
  • Fax: 661-255-7951
Mailing address:
  • Phone: 818-324-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA046229
License Number StateCA

VIII. Authorized Official

Name: JAMES WEAGLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-324-4625